Guest Columns

A matter of policy: Increasing flu immunization compliance

Hospitals and nursing homes are often ‘ground zero' for viruses and bacteria. But more than 25% of all healthcare workers in America have not had a flu shot. Which begs the question: If you had to choose a nursing home, would you choose a facility where most of the staff had received flu shots — or a place where only half were immunized?

Here at Rochester Manor Health and Rehabilitation Center, most of our families and residents are extremely concerned about picking up infections, including the flu. Their concern is understandable, because elderly people — the majority of our residents — are more susceptible to the flu virus.

Of course, our center does have protocols in place to prevent the spread of infection. Frequent hand washing is one of the most important things we do. But in recent years, we've also tried to encourage our staff members to get immunized against the flu.
Over the years we've tried a number of different approaches to incentivize employees, with varying success. The one thing we did not do was to make flu shots mandatory, as this wasn't compatible with our management philosophy. So we had to come up with a different strategy to motivate compliance among staff members.
At first, we tried an educational approach: We sent out notices explaining the benefits of immunization and offered to pay for flu shots for all employees. We had good response to that, but it fell short of our expectations. Next, we offered a chance for cash rewards to anyone who had gotten a flu shot. That motivated a few more people. We also offered food rewards, including free chocolate and Dunkin Donut gift cards.
Everything worked ... a little. Each incentive persuaded three or four new people to get a flu shot. But it was a slow and painful process. We still didn't want to make flu shots mandatory. So we had to look for another approach.
We found the answer in a one-page company policy document, an agreement that all staff members are required to sign when they begin their employment with us. Signing this document, called “Informed Refusal of influenza Immunization” is standard procedure at Rochester Manor.

But we found that few employees had actually paid close attention to what the document actually says — or what it implies for their salaries.
Basically, our informed refusal document explains how important immunization is for our center and how it protects our vulnerable population of seniors. But it also warns employees that in the event our center does have an influenza outbreak, employees who chose not to be vaccinated may be shut out and prevented from working during the outbreak by order of the center's medical officer. In that case, any missed workdays are not counted as sick leave, and the employee are not be eligible for pay.
The policy also notes that unvaccinated employees will be required to pay for their own treatment costs, should they come down with the flu, and will be required to “take precautionary measures, for a prescribed time” before returning to work.
Once we reviewed this policy with immunization holdouts at our center, compliance increased dramatically. Employees now realize, if they didn't before, that we're serious about protecting our center from influenza. And they also know that if we have an outbreak here, unvaccinated staff members will not be allowed to work. Realizing that a flu outbreak could mean no paycheck has really driven the message home.

Since we started enforcing our policy, over 85% of our staff members have gotten flu shots. We still have a few who are not immunized – people who cannot get shots for medical reasons or those who have philosophical objections to immunizations of any kind – but the majority of our employees have gotten on board. We started this approach several years ago, and since then, every single nursing home in our community has been closed due to a flu outbreak – except for us. We've been able to keep our doors open, keep our patients and families safe, and keep our staff working. This year, we received a deficiency-free rating from the Joint Commission for Accreditation of Healthcare Organizations (JCAHO). They told us that our flu prevention policies played a key role in our high rating.

Mary Flynn is the executive director of the Rochester Manor Health and Rehabilitation Center in Rochester, NH.